Enterovirus outbreak dynamics

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Science  24 Aug 2018:
Vol. 361, Issue 6404, pp. 755-756
DOI: 10.1126/science.aau6932

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Outbreaks of pathogens that cause acute immunizing infections are often highly predictable. The most studied example is measles, for which case incidence over time is robustly explained with simple mathematical models that account for variations in the number of susceptible individuals through infection and birth (1). By contrast, it is more challenging to predict outbreaks of infectious diseases that exhibit complex patterns of immunity, such as influenza, for which antigenic characteristics of circulating strains continuously change (2). Enteroviruses can cause a wide spectrum of clinical manifestations—including hand-foot-and-mouth disease (HFMD)—with potentially severe neurological complications (3). With more than 100 serotypes that may have varying immunological cross-protection (3), predicting the transmission dynamics of enteroviruses was expected to be difficult. On page 800 of this issue, Pons-Salort and Grassly (4) demonstrate that in contrast to this expectation, enteroviruses are highly predictable pathogens, with outbreaks largely driven by serotype-specific long-term immunity and birth rates. This opens the door to model-guided public health planning and outbreak preparedness.